Key result
Elevated blood urea nitrogen (>50 mg/dL) at admission independently predicted in-hospital mortality in acute coronary syndrome patients (OR 4.01; 95% CI 1.0-7.0; p=0.001).
Why the study?
While TIMI and GRACE scores are used for prognosis in ACS, examining BUN and creatinine alongside them may also prove favorable for mortality risk assessment.
Do admission blood urea nitrogen and creatinine levels predict in-hospital mortality in patients with acute coronary syndrome?
Cohort (n=1,463)
No
Do admission blood urea nitrogen and creatinine levels predict in-hospital mortality in patients with acute coronary syndrome?
Odds Ratio: 4.01 (95% CI 1–7)
p-value: p=0.001
Elevated blood urea nitrogen at admission is a strong and more accurate predictor of in-hospital mortality than creatinine in patients with acute coronary syndrome.
BUN/creatinine may aid ACS prognostication; leaves open incremental value over TIMI/GRACE in validated cohorts.
Background : Acute coronary syndrome (ACS) is one of the major causes of morbidity and mortality worldwide. Thus, it is important to effectively diagnose and determine prognosis and mortality risk. While criteria such as Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) score are clinically used to work out the prognosis of patients with ACS, the examination of Blood Urea Nitrogen (BUN) and creatinine alongside in predicting outcome may prove favorable as well. This study aimed to determine the efficacy of BUN and creatinine in mortality risk assessment of patients with ACS and to find which one is better. Subjects and Method : This was an analytical study with a cohort retrospective design included 1463 ACS patients in Dr. Moewardi hospital from January 2014 to July 2018. The relationship between admission BUN, creatinine level, and in-hospital mortality was analyzed with chi-square and logistic regression. Receiver Operating Characteristic (ROC) curve to determine which one better as a predictor of in-hospital mortality. Results : The mean age of patients was 60 years old (mean= 60.08; SD= 11.04), which 72.9% were men. From all sample, 232 (15.9%) patients were died. In binary log regression models, elevated BUN (>50 mg/dL) at admission was an independent predictor of in-hospital mortality (OR= 4.01; 95% CI= 1.0 to 7.0; p= 0.001). Similar results were obtained for elevated creatinine (>1.3 mg/dL) at admission (OR= 3.6; 95% CI= 2.2 to 5.8; p= 0.031). ROC curves showed that area under the curve (AUC) of BUN (0.87) was higher than AUC of creatinine (0.61). Conclusion : Elevated BUN and creatinine are independent predictors of in-hospital mortality in ACS patients. A high-level of BUN at admission is a more accurate predictor of in-hospital mortality than creatinine. Keyword s : blood urea nitrogen, creatinine, acute coronary syndrome Correspondence: Trisulo Wasyanto. Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sebelas Maret/ Dr. Moewardi Hospital. Jl. Kol. Sutarto 132, Surakarta 57126. Indonesia. Email: trisulo.wasyanto@gmail.com. Indonesian Journal of Medicine (2019), 4(3): 241-251 https://doi.org/10.26911/theijmed.2019.04.03.07
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Wasyanto et al. (2019) conducted a cohort in Acute Coronary Syndrome (n=1,463). Elevated Blood Urea Nitrogen (>50 mg/dL) at admission vs. Non-elevated Blood Urea Nitrogen was evaluated on In-hospital mortality (OR 4.01, 95% CI 1.0-7.0, p=0.001). Elevated blood urea nitrogen (>50 mg/dL) at admission independently predicted in-hospital mortality in acute coronary syndrome patients (OR 4.01; 95% CI 1.0-7.0; p=0.001).
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